The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #53301

Bentson H. McFarland, MD, PhD¹, Frances L. Lynch, PhD², Donald K. Freeborn, PhD², Daniel M. Dickinson, CADC II³, Michael R. Polen, MA², and Carla A. Green, PhD, MPH². (1) Department of Psychiatry, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, 503 245-6550, mcfarlab@ohsu.edu, (2) Center for Health Research, Kaiser Permanente, 3800 North Interstate Avenue, Portland, OR 97227-1110, (3) Department of Addiction Medicine, Kaiser Permanente, 10163 S.E. Sunnyside Road, Suite 490, Clackamas, OR 97015-5720

Medicaid clients are disproportionately plagued by chemical dependency. Moreover, Medicaid is a growing payer for alcohol and drug abuse treatment. As Medicaid clients have come to be enrolled in managed care systems, concern has arisen regarding the impact of organizational and financial arrangements on substance abuse treatment. This project examined enrollment duration for Medicaid and non-Medicaid alcohol and drug abuse treatment clients in a large health maintenance organization (HMO). Subjects were 1,174 adult Medicaid clients who contacted the HMO’s addiction medicine department in 1996 or 1997 as well as age and sex matched non-Medicaid HMO addiction medicine patients. Survival analysis showed that the Medicaid chemical dependency clients had much shorter enrollment duration (median of 10 months) than the non-Medicaid clients (33 months), Medicaid HMO members generally (13 months), and commercial HMO members (37 months). Survival analyses of enrollment duration for clients who had treatment recommended (52% female, average age 34, 67% previously treated, 60% previously arrested, 72% with combined alcohol plus drug problems) showed Medicaid coverage was the most powerful predictor of membership termination (p < .0001) even after adjustment for demographic, clinical, legal, and addiction characteristics. Over 25% of Medicaid chemical dependency clients lost coverage within six months of first contact. Few Medicaid addiction medicine clients switched HMOs or obtained commercial coverage. These results suggest that state Medicaid policies make it difficult for clients to attain the recommended duration of chemical dependency services. Medicaid enrollment policies need to be modified if substance abuse clients are to obtain sufficient treatment.

Learning Objectives:

At the conclusion of this session participants will be able to: (
• Recognize the importance of Medicaid funding for alcohol and drug abuse treatment, (
• List factors influencing duration of membership for Medicaid clients enrolled in health maintenance organizations,(
• Describe clinical implications of brief enrollment duration for Medicaid chemical dependency treatment clients, and (
• Discuss policy implications for state Medicaid programs of enrollment duration data.

Keywords: Medicaid Managed Care, Drug Abuse Treatment

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: State employee